Long Term Care

Sitting just below the absence of common governance over the scheduling functions, our client had a history of challenges in maintaining schedules for their facilities. Although schedules were based on standard templates for similar-sized facilities there was a pattern of employees swapping shifts at the last minute. This resulted in a vicious circle or domino effect of new requests for leave, followed by additional swap requests, driving new leave requests, and so on. Each site did not have a scheduler to fill empty shifts, although some homes did have their receptionist cover this role.  This resulted in a high degree of variance across buildings.  Sites that had staffing issues and were under-performing but were perplexed as most of them had some sort of clock in and clock out system. However, central timekeeping was overwhelmed with inquires after each pay period from employees who were underpaid, and it is easy to project that a similar number of employees were overpaid. Many of the staff hired as care aides were unable to get the hours they needed to live. They had to supplement their income by working at multiple homes outside of the organization, and sometimes outside of healthcare altogether.

 

In this situation the priority solution was to design and implement stronger governance and to formalize it alongside the implementation of new vacation planning and approval guidelines and cleaner reporting. The current metrics that came flying in each week from a centralized reporting division were understood by the Executive Directors, but not by the manager responsible for most of the leave approvals. Standard business processes were designed with an eye to reinforce the new governance model. The business processes clearly outlined responsibilities for staff, managers, and the scheduling function.  One new process on shift swaps included timeframes on requests and approvals to ensure requests were made in advance and to reduce the panic of approving or denying last-minute requests. This helped managers make better informed less reactive decisions. Staff were encouraged to better plan their schedules in advance, to be more accountable, and to submit availability for additional shifts.

To support the new governance structure and staff responsible for filling shifts to make decisions that reduced the cost to the organization, a library of on-boarding, learning, reinforcement, and sustainment tools were created.  Rounding out our partnership was the creation of schedule templates which provided better patterns and lines, aligned to care packages and resident needs, for example, with multiple shift lengths and varying start and end times. These schedules were centrally maintained and any deviation from baselines tracked as part of centralized reporting.

One of the few costs you can control in long term care is your labor, and your biggest assets are your people given the consistency they provide to residents and families. Finding a way to control costs and improve employee loyalty may appear difficult on the surface, but can be achieved using our integrated consulting services to optimize your staffing.